New member

Been a while since my last question. Hoping someone can help us out or guide us. My dad is in the late stages of ALS and is now living in a residence and having multiple panic attacks per day. This has been going on for the last 2 weeks and he is being brought back and forth from the hospital to the residence. We don’t want him to be so heavily drugged that he is barely conscious but we also want him to be comfortable. Is there anything that anyone can suggest? A certain medication that worked well? They hooked up his Bipap to oxygen at the hospital and their giving him Ativan and low dose morphine. Any suggestion would be greatly appreciated. Is this just what is expect at the end stage of ALS?

Moderator

If he is truly in the last stages (which, since they are giving him oxygen, I hope he is), he is likely experiencing air hunger that is outpacing the drugs.

If that is the case, and the BiPAP settings have been adjusted up or down to his comfort (let me know if you need help with that), then less consciousness may be the comfort tradeoff. I would say what you want to say, bring in who he needs to see, try to ascertain his wishes (the tradeoff is pretty clear) and then with his agreement flip the switch all the way over to the comfort side, providing that clarity to the staff as well.

Think of how you will remember these last days, and how he would want to be remembered. It is not in going back and forth to the hospital. It is in peace, at rest, with his loved ones at his side.

Senior member

I agree with cannabis oil. I use a strain that has 12.5% cbd and 12.5% thc. It works for spasticity, pain and is wonderful on your mood. I get mine through a doctor. The company is called CannTrust. They are very good at a consistent product and availability is excellent compared to other licenced providers. This can take time to set up, but there are storefronts in Toronto selling legally. It could be worth a look.
Vincent

Extremely helpful member

Drug of choice for panic disorder is Xanax because it's fast acting. You can put it under tongue or in a tube but, like CBD oil, under the tongue is quicker. Also, once something is working, continue it. Don't stop or reduce unless it adversely affects him.

Moderator

Note: Ativan and Xanax are both benzodiazepines. The idea would be not to get to the point where you need a fast-acting version, since that means someone is very uncomfortable, but instead increase the one you are using regularly in dose and/or frequency, titrating to comfort.

Vincent, Bobby's dad is in California, I believe. Since responses to CBD oil can vary and can include paranoia/stimulation, especially if someone is frail and undernourished, I'm not sure I'd try that in the last stage. The right combo of a benzo and morphine in panic is more of a sure thing.

Member

I hope you are doing well this morning. I just want to clarify the difference between CBD and medicinal or regular marijuana. Marijuana, even if purchased through a state approved facility for medical purposes will have varying degrees of THC and CBD in it. Pharmacists or consultants at a dispensary will guide you somewhere between nearly 100% CBD and nearly 100% THC. You can only legally buy marijuana in states where it is approved for medical purposes, or it is legal to buy for everyone.

THC produces the psychoactive/getting high effects that everyone associates with marijuana. CBD essentially causes the feeling-mellow effects everyone associates with marijuana. Any cannabis with more than a trace of THC in it has the potential to increase anxiety and cause problems like paranoia. Pure (or close to it) CBD, on the other hand, tends to alleviate those issues and is a nice option for people who need to gently encourage relaxation. Taking around .5 to 1.5 ml of oil under the tongue, or through a feeding tube gives a very subtle sense of an easing of tension. It may or may not cause drowsiness, but it won’t knock someone out. My PALS takes it on occasion if she is having challenges with a lot of secretions, is feeling anxious in general, or experiencing air hunger. In general she prefers it to the small dose of Valium she has been prescribed. She doesn’t like feeling drowsy or sluggish during the day, a side effect of Valium and most other prescribed meds along those lines.

I’d recommend your dad stay away from anything with THC in it. Be sure to run any of this by his doctor and/or people at his ALS clinic. Check out that website I mentioned in my earlier post for more detailed and educated insight.

Extremely helpful member

Ativan must be the cheapest benzo because all the hospices and hospitals use it. It caused me anxiety. Neither Valium nor Xanax did.

My neurologist/psychiatrist recommended Xanax for panic disorder. He said once I built a therapeutic level I should stay on it. I was on it for 20 years with no side effects. I never had to increase the dose. I never had another panic attack. When I started taking CBD oil (never should be measured in ml because there are different strengths. Always measure in milligrams) I was able to easily come off Xanax after 20 years with no withdrawal whatsoever.

Valium is often used for muscle relaxation and I use it daily.

I take about 50 milligrams of CBD (Charlotte's Web) each night before bed. I take 5 mg. of Valium twice a day.

People are different. Response to drugs, even in the same class, can be dramatically different. For example, Morphine gives me horrible anxiety but Oxy does not.

New member

Thank you all for your replies!! My dad has been suffering with air hunger and last panic attack that he had the head nurse said they will give him shots of morphine but if that doesn’t work they will give him vercel which they did and it calmed him down. We were informed that if this happens again which I’m sure it will shortly they will give him the vercel again which will render him completely unconscious until he passes. We have come to terms with him passing but I don’t believe he has. He still wants to live and is naturally really scared to pass on.

Ironically though today he did his cough assist and was able to clear a large amount of phlegm and seems to be feeling much better and is having a great day.